Spinal stenosis treatment options
Non-surgical treatment for spinal stenosis
Depending on the severity of symptoms, spinal stenosis
can often be managed through non-surgical means. The
two most common treatments for spinal stenosis include:
-
Activity modification to treat spinal stenosis.
Patients are usually counseled to avoid activities
that cause the adverse symptoms of spinal stenosis.
Patients are typically more comfortable while flexed
forward. Examples of activity modification might
include: walking while bent over and leaning on
a walker or shopping cart instead of walking upright;
stationary biking instead of walking for exercise;
sitting in a recliner instead of on a straight-back
chair.
-
Epidural injections to treat spinal stenosis.
An injection of cortisone into the space outside
the dura (the epidural space) can temporarily relieve
symptoms of spinal stenosis. While these injections
can seldom be considered curative, they can alleviate
the pain in about 50% of cases. Up to three injections
over a course of several months can be tried. Although
they are not considered diagnostic in and of themselves,
generally, if the pain
caused by spinal stenosis
is relieved by an injection
the patient can also be expected to have a good
result if they later choose surgery.
Anti-inflammatory medication (such as ibuprofen,
aspirin) may be helpful
intreating spinal stenosis. Exercise is important to
maintain
strength, but usually has little lasting value in alleviating
the symptoms. Some physicians recommend a multiple
B-complex
vitamin with 1200 mg of folic acid daily, but this
has not been substantiated in the literature.
Some people may successfully manage the symptoms of
spinal stenosis with the non-surgical therapies either
for a period of time or indefinitely. The key in
choosing whether or not to have surgery is the degree
of disability and disabling pain
pain from spinal stenosis. As a guideline,
when the (usually elderly) patient can no longer
walk sufficiently to care for himself or herself,
or to go shopping for essentials, then surgery
for spinal stenosis is usually recommended.
Surgery for spinal stenosis is mainly designed to
increase a patient’s
activity tolerance, so they can do more activity with
less pain.
Surgery treatment for spinal stenosis
In most cases of advanced stenosis (spinal or vascular),
decompressive surgery is required. There are several
opinions and techniques used in spinal stenosis surgery,
but there are key components common to all such approaches.
-
First and foremost, a correct and very detailed
anatomical diagnosis is required - knowing exactly
where to go while considering the possibility of
a double or triple location of choking of a nerve,
on one or both sides.
-
Secondly, the surgery should not create a new problem,
such as nerve injury or a structural instability
that might require additional surgeries.
-
Thirdly, the approach
to correcting spinal stenosis
should be minimally destructive
of normal structures. The surgeon should strive
to leave as much as possible of the normal or slightly
abnormal tissues alone. This again points to the
importance of exactly identifying the offending
stenosis.
-
Fourthly, the metabolic and physical status of
the patient is important. Even in experienced hands
a decompressive procedure, especially if more than
one level and if bilateral procedures are needed,
may require a few hours of anesthesia, and this
is not well tolerated by some patients. Some surgeons
will perform the
spinal stenosis
surgery under an epidural anesthetic
instead of a general.
Fortunately, a decompression surgery for spinal stenosis
is among the most rewarding surgical methods used
on the spine (second only to herniated disc), because
generally patients do well and are able to increase
their activity and have a better walking tolerance
postoperatively.
For more information on decompression surgery, please
see Lumbar
decompression surgery.
By:
Charles Dean Ray, MD
October 25, 2002
|
|
